Extent of parahippocampal ablation is associated with seizure freedom after laser amygdalohippocampotomy

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  • 1 Departments of Neurosurgery and
  • | 2 Neurology, University of Chicago, Illinois
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OBJECTIVE

The authors aimed to examine the relationship between mesial temporal subregion ablation volume and seizure outcome in a diverse cohort of patients who underwent stereotactic laser amygdalohippocampotomy (SLAH) for mesial temporal lobe epilepsy (MTLE).

METHODS

Seizure outcomes and pre- and postoperative images were retrospectively reviewed in patients with MTLE who underwent SLAH at a single institution. Mesial temporal subregions and the contrast-enhancing ablation volume were manually segmented. Pre- and postoperative MR images were coregistered to assess anatomical ablation. Postoperative MRI and ablation volumes were also spatially normalized, enabling the assessment of seizure outcome with heat maps.

RESULTS

Twenty-eight patients with MTLE underwent SLAH, 15 of whom had mesial temporal sclerosis (MTS). The rate of Engel class I outcome at 1 year after SLAH was 39% overall: 47% in patients with MTS and 31% in patients without MTS. The percentage of parahippocampal gyrus (PHG) ablated was higher in patients with an Engel class I outcome (40% vs 25%, p = 0.04). Subregion analysis revealed that extent of ablation in the parahippocampal cortex (35% vs 19%, p = 0.03) and angular bundle (64% vs 43%, p = 0.02) was positively associated with Engel class I outcome. The degree of amygdalohippocampal complex (AHC) ablated was not associated with seizure outcome (p = 0.30).

CONCLUSIONS

Although the AHC was the described target of SLAH, seizure outcome in this cohort was associated with degree of ablation for the PHG, not the AHC. Complete coverage of both the AHC and PHG is technically challenging, and more work is needed to optimize seizure outcome after SLAH.

ABBREVIATIONS

AHC = amygdalohippocampal complex; ATL = anterior temporal lobectomy; EEG = electroencephalography; Freqab = ablation frequency; MNI = Montreal Neurological Institute; MTLE = mesial TLE; MTS = mesial temporal sclerosis; PHG = parahippocampal gyrus; SelAH = selective amygdalohippocampectomy; SLAH = stereotactic laser amygdalohippocampotomy; TLE = temporal lobe epilepsy.

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Contributor Notes

Correspondence David Satzer: University of Chicago, IL. david.satzer@uchospitals.edu.

INCLUDE WHEN CITING Published online June 4, 2021; DOI: 10.3171/2020.11.JNS203261.

Disclosures Dr. Warnke: participation in the SLATE Trial sponsored by Medtronic.

  • 1

    Semah F, Picot MC, Adam C, et al. Is the underlying cause of epilepsy a major prognostic factor for recurrence? Neurology. 1998;51(5):12561262.

    • Search Google Scholar
    • Export Citation
  • 2

    Téllez-Zenteno JF, Hernández-Ronquillo L. A review of the epidemiology of temporal lobe epilepsy. Epilepsy Res Treat. 2012;2012:630853.

    • Search Google Scholar
    • Export Citation
  • 3

    Téllez-Zenteno JF, Dhar R, Wiebe S. Long-term seizure outcomes following epilepsy surgery: a systematic review and meta-analysis. Brain. 2005;128(Pt 5):11881198.

    • Search Google Scholar
    • Export Citation
  • 4

    Al-Otaibi F, Baeesa SS, Parrent AG, et al. Surgical techniques for the treatment of temporal lobe epilepsy. Epilepsy Res Treat. 2012;2012:374848.

    • Search Google Scholar
    • Export Citation
  • 5

    Giacomini L, de Souza JPSA, Formentin C, et al. Temporal lobe structural evaluation after transsylvian selective amygdalohippocampectomy. Neurosurg Focus. 2020;48(4):E14.

    • Search Google Scholar
    • Export Citation
  • 6

    Gross RE, Stern MA, Willie JT, et al. Stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Ann Neurol. 2018;83(3):575587.

    • Search Google Scholar
    • Export Citation
  • 7

    Wu C, Jermakowicz WJ, Chakravorti S, et al. Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy: a multicenter study of 234 patients. Epilepsia. 2019;60(6):11711183.

    • Search Google Scholar
    • Export Citation
  • 8

    Wieser HG, Ortega M, Friedman A, Yonekawa Y. Long-term seizure outcomes following amygdalohippocampectomy. J Neurosurg. 2003;98(4):751763.

    • Search Google Scholar
    • Export Citation
  • 9

    Tanriverdi T, Dudley RW, Hasan A, et al. Memory outcome after temporal lobe epilepsy surgery: corticoamygdalohippocampectomy versus selective amygdalohippocampectomy. J Neurosurg. 2010;113(6):11641175.

    • Search Google Scholar
    • Export Citation
  • 10

    Wiebe S, Blume WT, Girvin JP, Eliasziw M. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med. 2001;345(5):311318.

    • Search Google Scholar
    • Export Citation
  • 11

    Schramm J. Temporal lobe epilepsy surgery and the quest for optimal extent of resection: a review. Epilepsia. 2008;49(8):12961307.

  • 12

    Donos C, Breier J, Friedman E, et al. Laser ablation for mesial temporal lobe epilepsy: surgical and cognitive outcomes with and without mesial temporal sclerosis. Epilepsia. 2018;59(7):14211432.

    • Search Google Scholar
    • Export Citation
  • 13

    Kang JY, Wu C, Tracy J, et al. Laser interstitial thermal therapy for medically intractable mesial temporal lobe epilepsy. Epilepsia. 2016;57(2):325334.

    • Search Google Scholar
    • Export Citation
  • 14

    Vakharia VN, Sparks R, Li K, et al. Automated trajectory planning for laser interstitial thermal therapy in mesial temporal lobe epilepsy. Epilepsia. 2018;59(4):814824.

    • Search Google Scholar
    • Export Citation
  • 15

    Jermakowicz WJ, Kanner AM, Sur S, et al. Laser thermal ablation for mesiotemporal epilepsy: analysis of ablation volumes and trajectories. Epilepsia. 2017;58(5):801810.

    • Search Google Scholar
    • Export Citation
  • 16

    Vismer MS, Forcelli PA, Skopin MD, et al. The piriform, perirhinal, and entorhinal cortex in seizure generation. Front Neural Circuits. 2015;9:27.

    • Search Google Scholar
    • Export Citation
  • 17

    Bartolomei F, Khalil M, Wendling F, et al. Entorhinal cortex involvement in human mesial temporal lobe epilepsy: an electrophysiologic and volumetric study. Epilepsia. 2005;46(5):677687.

    • Search Google Scholar
    • Export Citation
  • 18

    Scharfman HE. Epileptogenesis in the parahippocampal region. Parallels with the dentate gyrus. Ann N Y Acad Sci. 2000;911:305327.

  • 19

    Karunakaran S, Rollo MJ, Kim K, et al. The interictal mesial temporal lobe epilepsy network. Epilepsia. 2018;59(1):244258.

  • 20

    Galovic M, Baudracco I, Wright-Goff E, et al. Association of piriform cortex resection with surgical outcomes in patients with temporal lobe epilepsy. JAMA Neurol. 2019;76(6):690700.

    • Search Google Scholar
    • Export Citation
  • 21

    Tao JX, Wu S, Lacy M, et al. Stereotactic EEG-guided laser interstitial thermal therapy for mesial temporal lobe epilepsy. J Neurol Neurosurg Psychiatry. 2018;89(5):542548.

    • Search Google Scholar
    • Export Citation
  • 22

    Gross R. The latest on lasers: improving the outcome of MRg-LITT amygdalohippocampotomy. Epilepsy Curr. 2018;18(6):382386.

  • 23

    Yushkevich PA, Piven J, Hazlett HC, et al. User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage. 2006;31(3):11161128.

    • Search Google Scholar
    • Export Citation
  • 24

    Schneider CA, Rasband WS, Eliceiri KW. NIH Image to ImageJ: 25 years of image analysis. Nat Methods. 2012;9(7):671675.

  • 25

    Berron D, Vieweg P, Hochkeppler A, et al. A protocol for manual segmentation of medial temporal lobe subregions in 7 Tesla MRI. Neuroimage Clin. 2017;15:466482.

    • Search Google Scholar
    • Export Citation
  • 26

    Moore M, Hu Y, Woo S, et al. A comprehensive protocol for manual segmentation of the medial temporal lobe structures. J Vis Exp. 2014;89:50991.

    • Search Google Scholar
    • Export Citation
  • 27

    Kivisaari S, Probst A, Taylor K. The perirhinal, entorhinal, and parahippocampal cortices and hippocampus: an overview of functional anatomy and protocol for their segmentation in MR images. In: Ulmer S, Jansen O, eds. fMRI: Basics and Clinical Applications. 3rd ed. Springer; 2013:355383.

    • Search Google Scholar
    • Export Citation
  • 28

    Le S, Ho AL, Fisher RS, et al. Laser interstitial thermal therapy (LITT): seizure outcomes for refractory mesial temporal lobe epilepsy. Epilepsy Behav. 2018;89:3741.

    • Search Google Scholar
    • Export Citation
  • 29

    Grewal SS, Zimmerman RS, Worrell G, et al. Laser ablation for mesial temporal epilepsy: a multi-site, single institutional series. J Neurosurg. 2019;130(6):20552062.

    • Search Google Scholar
    • Export Citation
  • 30

    Smart O, Rolston JD, Epstein CM, Gross RE. Hippocampal seizure-onset laterality can change over long timescales: a same-patient observation over 500 days. Epilepsy Behav Case Rep. 2013;1:5661.

    • Search Google Scholar
    • Export Citation
  • 31

    Malikova H, Kramska L, Vojtech Z, et al. Different surgical approaches for mesial temporal epilepsy: resection extent, seizure, and neuropsychological outcomes. Stereotact Funct Neurosurg. 2014;92(6):372380.

    • Search Google Scholar
    • Export Citation
  • 32

    Bermudez CI, Jermakowicz WJ, Kolcun JPG, et al. Cognitive outcomes following laser interstitial therapy for mesiotemporal epilepsies. Neurol Clin Pract. 2020;10(4):314323.

    • Search Google Scholar
    • Export Citation
  • 33

    Rusinek H, Brys M, Glodzik L, et al. Hippocampal blood flow in normal aging measured with arterial spin labeling at 3T. Magn Reson Med. 2011;65(1):128137.

    • Search Google Scholar
    • Export Citation
  • 34

    Sagher O, Thawani JP, Etame AB, Gomez-Hassan DM. Seizure outcomes and mesial resection volumes following selective amygdalohippocampectomy and temporal lobectomy. Neurosurg Focus. 2012;32(3):E8.

    • Search Google Scholar
    • Export Citation
  • 35

    Schramm J, Lehmann TN, Zentner J, et al. Randomized controlled trial of 2.5-cm versus 3.5-cm mesial temporal resection—part 2: volumetric resection extent and subgroup analyses. Acta Neurochir (Wien). 2011;153(2):221228.

    • Search Google Scholar
    • Export Citation
  • 36

    Bonilha L, Kobayashi E, Mattos JP, et al. Value of extent of hippocampal resection in the surgical treatment of temporal lobe epilepsy. Arq Neuropsiquiatr. 2004;62(1):1520.

    • Search Google Scholar
    • Export Citation
  • 37

    Bonilha L, Yasuda CL, Rorden C, et al. Does resection of the medial temporal lobe improve the outcome of temporal lobe epilepsy surgery? Epilepsia. 2007;48(3):571578.

    • Search Google Scholar
    • Export Citation
  • 38

    Siegel AM, Wieser HG, Wichmann W, Yasargil GM. Relationships between MR-imaged total amount of tissue removed, resection scores of specific mediobasal limbic subcompartments and clinical outcome following selective amygdalohippocampectomy. Epilepsy Res. 1990;6(1):5665.

    • Search Google Scholar
    • Export Citation
  • 39

    Abosch A, Bernasconi N, Boling W, et al. Factors predictive of suboptimal seizure control following selective amygdalohippocampectomy. J Neurosurg. 2002;97(5):11421151.

    • Search Google Scholar
    • Export Citation
  • 40

    Gonçalves-Ferreira A, Rainha-Campos A, Franco A, et al. Amygdalohippocampotomy for mesial temporal lobe sclerosis: epilepsy outcome 5 years after surgery. Acta Neurochir (Wien). 2017;159(12):24432448.

    • Search Google Scholar
    • Export Citation
  • 41

    Massager N, Tugendhaft P, Depondt C, et al. Long-term outcome of surgical disconnection of the epileptic zone as an alternative to resection for nonlesional mesial temporal epilepsy. J Neurol Neurosurg Psychiatry. 2013;84(12):13781383.

    • Search Google Scholar
    • Export Citation
  • 42

    Usami K, Kubota M, Kawai K, et al. Long-term outcome and neuroradiologic changes after multiple hippocampal transection combined with multiple subpial transection or lesionectomy for temporal lobe epilepsy. Epilepsia. 2016;57(6):931940.

    • Search Google Scholar
    • Export Citation
  • 43

    Augustinack JC, Helmer K, Huber KE, et al. Direct visualization of the perforant pathway in the human brain with ex vivo diffusion tensor imaging. Front Hum Neurosci. 2010;4:42.

    • Search Google Scholar
    • Export Citation
  • 44

    Janz P, Savanthrapadian S, Häussler U, et al. Synaptic remodeling of entorhinal input contributes to an aberrant hippocampal network in temporal lobe epilepsy. Cereb Cortex. 2017;27(3):23482364.

    • Search Google Scholar
    • Export Citation

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